What You Should Know:
– XiFin, Inc., a leading provider of innovative healthcare information technologies and services that deliver artificial intelligence (AI)-enabled operational efficiency, interoperability, and simplicity, announced it has significantly enhanced its Payor Rate Transparency Monitor, adding two major payors—Humana and Blue Shield of California (BSCA)—to provide healthcare organizations with deeper insights into in-network contracted rates across millions of payor-reported records.
– Combined with new analytic data and user interface enhancements, the Payor Rate Transparency Monitor furthers XiFin’s commitment to empowering healthcare providers with the tools they need to navigate complex reimbursement landscapes and enhance their financial performance.
XiFin: Transforming Healthcare with Advanced Payor Transparency Tools
XiFin, a leader in healthcare information technology, is redefining how healthcare organizations manage complex systems and data in a fast-evolving industry. XiFin leverages AI-powered technologies to boost operational efficiency, streamline interoperability, and simplify critical workflows. Through its revenue cycle management, clinical workflow solutions, laboratory information system, and patient engagement tools, XiFin empowers healthcare organizations to optimize their financial health, streamline operations, and adopt forward-thinking business strategies.
Payor Rate Transparency Monitor: Enhanced Tools for In-Depth Payor Analysis
The XiFin Payor Rate Transparency Monitor—a pioneering, online tool—has been upgraded to provide a more in-depth and real-time view of the payor landscape. Now integrating data from over 7 terabytes of information as mandated by the CMS Transparency in Coverage Final Rule, this monitor allows healthcare providers to easily access and compare payor data. The updated version includes new data from Humana and Blue Shield of California, processing more than 718,000 files—significantly more than prior data sources like UHC, Aetna, and Cigna. This expansion is a powerful resource for laboratories, diagnostic providers, and pharmacies looking to enhance reimbursement strategies and gain a competitive edge.
Key enhancements of the monitor include:
– Expanded Provider Reach: Broader access to data from leading payors.
– Performance Upgrades: Faster load times and optimized mobile and desktop compatibility.
– Customizable Analysis: Option to target specific payors for deeper analysis, facilitating effective contract negotiations and revenue cycle management.
Comprehensive Payor Intelligence Hub: Supporting Strategic Market Access
Complementing the Payor Rate Transparency Monitor, XiFin’s newly launched Payor Intelligence Hub is a centralized resource for healthcare organizations to develop stronger market access and payor relations strategies. This hub provides essential updates on billing, thought leadership through white papers, blogs, and webinars, and offers curated content for navigating changing payor behaviors.
The Hub’s monthly “Spotlight on Payor Behavior” provides critical insights, such as recent findings from XiFin data on Medicare and Medicare Advantage denial rates. For example, the analysis reveals shifts in denial reason codes for Medicare Advantage, with the primary code for non-covered items moving from CO-50 in 2019 to CO-96 in 2024, while traditional Medicare denial codes remained consistent. This valuable data helps providers stay compliant and proactive in an increasingly intricate healthcare landscape.
Through these innovative tools and resources, XiFin equips healthcare organizations to make informed, data-driven decisions that support long-term success.
“While payor rate data is publicly available, it is notoriously difficult to gather, process, and interpret,” said Jeff Carmichael, XiFin senior vice president, engineering. “XiFin’s Monitor offers a unique solution, enabling users to efficiently compare payor rates and trends across the industry. The addition of Humana and Blue Shield of California is a major step forward in our goal of providing healthcare organizations with the comprehensive data they need to thrive.”
